An Annotated Bibliography of Literature on
Mental Health in the Workplace
Anca Stepan
Cascadia College
May 25th, 2020
Introduction
The impact of COVID-19 on the general population as well as first responders and medical personnel has brought the conversation about mental health in the workplace and social stigma associated with mental illnesses into focus.
Given the prevalence of mental health related illnesses, workplace programs play a crucial role in prevention efforts, increasing resiliency, coping training and helping to reduce the social and cultural stigma overall.
This bibliography was put together as a result of a question seeking to understand what type of research is currently informing employee programs to help eliminate stigma associated with mental illness in the workplace.
Stigma is a deeply imbedded socio-cultural notion especially among cultures and environments where deviations from the norm are perceived as weaknesses or shameful and can prevent seeking help when experiencing or struggling with mental health illness or disorders. Examples of this can be found in police culture, health care industry or workers in high risk industries like construction, forestry, mining and oil/gas.
Public and private sector employers are offering health care plans comprehensive of mental health benefits like counselling, 24 hr. crisis hotlines, yet access to benefits is not enough to help combat the stigma and improve mental health in the workplace. Education surrounding mental health illnesses focused on awareness, identification, prevention and intervention is absolutely critical in normalizing and de-stigmatizing conversations surrounding it.
Programs like “PALS”, “TWM”, “Mates in Construction” and “Mates in Mining” have successfully implemented peer support systems which rely on training volunteer peer employees to identify and provide support to fellow co-workers experiencing mental health challenges as the first line of defense.
Other programs have addressed de-stigmatization of mental illnesses in the workplace by promoting a “culture of wellness” and inclusiveness by having senior leadership or executives humanize the subject and sharing their stories of personal struggle with mental illnesses.
Even if proven effective there are still gaps that may prevent employers from implementing these types of programs like volition, as currently there is no legislative mandate enforcing their adoption as well as a perceived vulnerability of opening up to risk and potential litigation.
There is a call for studying in more depth the economical ramifications of not addressing mental health illnesses which have been found to decrease productivity and increase absenteeism. This would incentivize corporations to recognize the ROI of such programs.
List of Tags
Mental Health
Mental Health Education
Workplace Mental Health
Mental Health Literacy
Social Stigma
Stigma
Employee Programs
Workplace Programs
Mental Health Programs
Works Cited and Annotations
Carleton, R. Nicholas, Tracie O. Afifi, Sarah Turner, Tamara Taillieu, Adam D. Vaughan, Gregory S. Anderson, Rosemary Ricciardelli, et al. 2020. “Mental Health Training, Attitudes toward Support, and Screening Positive for Mental Disorders.” Cognitive Behavior Therapy 49 (1): 55–73. https://doi.org/10.1080/16506073.2019.1575900.
Even though the focus of the study was Public Safety Personnel like dispatchers, firefighters, paramedics, police there is insight to be gained from this study as to whom employees turn to for support first given the available mental health resources and preparedness training. Even if provided with access to mental health training 74% of the 4020 respondents participating in the study said they would turn to their spouses first for support or only as a last resort access professional support (43% – 60%) and 67% to PSP leaders. This could indicate that accessibility to mental wellness and programs is not sufficient or efficient enough for a comprehensive approach.
Chung, Ka-Fai, Samson Tse, Chit-Tat Lee, and Wing-Man Chan. 2019. “Changes in Stigma Experience Among Mental Health Service Users over Time: A Qualitative Study with Focus Groups.” Community Mental Health Journal 55 (8): 1389–94. https://doi.org/10.1007/s10597-019-00442-4.
The Chinese mental health study focuses mostly on categories like social and perceived stigma and stigma coping. Even with the Chinese Government’s public expenditure on mental health programs in the past two decades the only category perceived to have sustained positive change was social stigma, in part due to media portrayal of mental health and the celebrity effect helping to foster greater acceptance and support of those dealing with mental health issues. The respondents still felt workplace stigma and discrimination had not seen improvements. The study provides additional insight into how cultural mores surrounding mental illness and stigma can influence may play an important role in one’s decision to seek help. Not only is mental health disclosure in the workplace frowned upon but from a cultural perspective “ Chinese patients may view themselves as bad sons or daughters while their family members may view them as a burden because they fail to achieve success and could not live up to the values of filial piety”. The study does not offer specific insight into what type of efforts outside of social stigma are being made to address workplace stigma or offers examples of any employee programs.
Dobson, Keith S., Andrew Szeto, and Stephanie Knaak. 2019. “The Working Mind: A Meta-Analysis of a Workplace Mental Health and Stigma Reduction Program.” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 64 (1 Suppl): 39S-47S. https://doi.org/10.1177/0706743719842559.
The Working Mind a Canadian pilot program that was developed to address mental health in the workplace and was implemented in a variety of workplace settings across Canada. The program is part of an overall strategy includes “mental health promotion, policies, and practices that foster a healthy workplace environment; stigma reduction to improve employee help seeking and to foster the creation of a supportive workplace culture; early intervention for appropriate care; policies to support employees who are struggling; and employee and family wellness benefits.”
The outcome of the program resulted in stigma reduction and improvement in resiliency skills as well as showing its effectiveness over time with participants improving “their understanding, willingness to discuss, and willingness to seek help or provide support to colleagues regarding mental health in the workplace; and the extent to which participants were using the program’s skills and knowledge.”
This study is important to acknowledge because not only mental health programs in the workplace help reduce stigma by increased knowledge but the skillset gained by employees will become in their turn a “peer partner support” tool similar to “Peers as Law Enforcement Support (PALS): An Early Prevention Program.” covered in the Van Hasselt. et al study.
Goetzel, Ron Z., Enid Chung Roemer, Calliope Holingue, M. Daniele Fallin, Katherine McCleary, William Eaton, Jacqueline Agnew, et al. 2018. “Mental Health in the Workplace: A Call to Action Proceedings From the Mental Health in the Workplace—Public Health Summit.” Journal of Occupational and Environmental Medicine 60 (4): 322–30. https://doi.org/10.1097/JOM.0000000000001271.
Goetzel et al article summarizes the call to action as a result of the “Health in the Workplace: Public Health Summit”, a summit held in October 2016, aiming to bring experts in mental and occupational health to help push the business community to take action to address mental health in the workplace challenges and the stigma associated with it. “The purpose of the Summit was to gather researchers, corporate executives, policy makers, and practitioners who would intelligently discuss workplace health promotion and disease prevention, policies and practices shown to be effective in improving the health and wellbeing of workers, gaps in the evidence regarding best and promising practices, and how to disseminate and implement effective programs.”
The article offers two cases studies of companies which have implemented a balanced
approach that supports both individual workers’ and the organization’s health, Prudential Financial and USAA.
Prudential’s policy of monitoring the impact supervisors have on workers’ health and wellbeing via an ongoing anonymous survey has helped assess employee’s happiness and satisfaction with their work environment. Another program implemented aims to address the stigma associated with mental health issue by having senior executives share personal stories on health and wellness and how the company’s programs have helped them by providing access to counseling or alcohol rehabilitation programs.
USAA offers its employees emotional learning tools in the form of online courses, videos,
and reading materials on topics like coping with feeling overwhelmed, interpersonal
communication, dealing with change, managing stress, post-traumatic stress disorder, and
problem solving.
The call to action counsel of experts has put together a toolkit for employers looking to implement mental health care and wellness programs which contains a series of recommendations, such as a “how to” guide, a “mental health in the workplace scorecard”, a “mental health in the workplace recognition program”, a partnership with a business school to establish an “executive training program” focused on mental health in the workplace.
The guide would be particularly useful to small to medium size business that do not have the resources or personnel to implement robust programs but would like to implement low-cost or no-cost programs.
This how to guide is critical and a great resource for business that do not have a budget to implement comprehensive mental health programs, in addition to access to medical benefits there is an opportunity for training employers and employees on awareness and support strategies.
Kristman, Vicki L., Jessica Lowey, Lynda Fraser, Susan Armstrong, and Silva Sawula. 2019. “A Multi-Faceted Community Intervention Is Associated with Knowledge and Standards of Workplace Mental Health: The Superior Mental Wellness @ Work Study.” BMC Public Health 19 (May). https://doi.org/10.1186/s12889-019-6976-x.
“Superior Mental Wellness @ Work” is a study addressing employers degree of familiarity with Canada’s “National Standard for Psychological Health and Safety in the Workplace”, which provides a comprehensive framework for organizations to identify hazards that may contribute to the psychological harm of employees. This is based on research showing “one in every five people will experience a common mental disorder at some point in their life [2]. Common mental disorders include depression, post-traumatic stress disorder (PTSD), panic disorder, and anxiety [2]. The annual cost of major depressive disorder alone was estimated to be approximately $210.5 billion in 2010 in the US, with 45–47% attributable to direct costs, 5% to suicide-related costs, and 48–50% to workplace costs [3], those being primarily(88%) lost productivity [4].” The goal of the study was to determine the association between a multi-faceted community intervention, the Superior Mental Wellness @ Work program, and outcomes which included prioritization of workplace mental health, familiarity with the National Standard and knowledge of mental health, challenges, stigma and its impact.
Even with mandated guide like the “National Standard” there is still a need to assess adherence and implementation to the standard, but a government run healthcare system would ensure all employers from public and private sectors are following a consistent and mandatory guideline. US healthcare policy mandates access to mental health care but does not offer a comprehensive multi-faceted approach on addressing mental health in the workplace, leaving it up to corporations to add additional non-access related policies and programs to boost mental health wellness and awareness.
Kubo, Hiroaki, Hiromi Urata, Ryoko Katsuki, Miyako Hirashima, Shion Ueno, Yuriko Suzuki, Daisuke Fujisawa, et al. 2018. “Development of MHFA-Based 2-h Educational Program for Early Intervention in Depression among Office Workers: A Single-Arm Pilot Trial.” PLoS ONE 13 (12). http://offcampus.lib.washington.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018-63626-001&site=ehost-live.
Study covers the implementation and results of a Japanese pilot program Mental Health First Aid (MHFA), a two-hour training course for employees which aims to increase public mental health literacy particularly depressing and suicide. The program was implemented at one company among 91employees of which 83 have provided answers to a self-rated questionnaire. “Changes in confidence and practical skills in early intervention of depression and suicide-prevention, and stigma toward mental health problems were evaluated using self-rated questionnaires at 3 time-points; pre-program, immediately post-program, and 1 month after the program.” The study offered awareness training with the use of role-play scenarios enabling workers to learn how to approach and respond to co-workers with depression and suicidal thoughts. The study emphasized the difficulty in approaching a person with depression in the workplace which was partly due to Japanese workplace culture and/or stigma.
A limitation of this study is that it was only performed on one company and it is a self-rated questionnaire which many not reflect the participant’s actual attitudes or behavior. The study mostly focuses on ways in which employees would engage fellow employees in personal conversation surrounding overall mental health and distress, within a cultural context which may draw a distinct line between professional and personal workplace conversation.
Mitake, Tomoe, Shinichi Iwasaki, Yasuhiko Deguchi, Tomoko Nitta, Yukako Nogi, Aya Kadowaki, Akihiro Niki, and Koki Inoue. 2019. “Relationship between Burnout and Mental-Illness-Related Stigma among Nonprofessional Occupational Mental Health Staff.” BioMed Research International, September, 1–6. https://doi.org/10.1155/2019/5921703
The Japanese study aims to clarify the association between mental-illness-related stigma and burnout among nonprofessional occupational mental health staff using the Link’s Devaluation-Discrimination Scale and the Maslach Burnout Inventory. The study defines stigma as a “multidimensional phenomenon that can be subcategorized into self-stigma, public stigma, and stigmatizing experiences”. The results of the study highlight the need for antistigma or antiburnout interventions to support employees’ mental health in the workplace. It suggests a proactive approach on burnout via cognitive behavioral training and counseling. Limitations to this study include the small sample size used and the type of questionnaire which is a self-reporting type. It also does not elaborate on the type of training currently being used.
Rauch, Susan. 2019. “Medicalizing the Disclosure of Mental Health: Transnational Perspectives of Ethical Workplace Policy Among Healthcare Workers.” World Medical & Health Policy 11 (4): 424–39. https://doi.org/10.1002/wmh3.317.
This article examines the medicalization of mental health workplace policy and is framed through the perspective of stigma associated with disclosure of mental health illnesses like bi-polar disorder by those in the health care industry like physicians and nurses. The study focuses on nursing board policies and peer assistance and monitoring programs, particularly in the United States. “Many criticize and regard the ethical practices of state Board of Nursing (BON) addiction monitoring programs that categorize bipolar disorder with substance abuse addiction. Desensitized identity in this sense redefines and diagnostically labels mental health illness as “addiction,” or, in the case of a nurse with bipolar that is well managed on medication, “addict.”
Medicalization of mental illnesses by instituting monitoring programs and enforcing disclosure is meant to help and support those suffering from mental illness like bi-polar disorder, but instead it creates a climate of stigmatization and discrimination. This scholarly rhetorical article calls for a more in-depth global study to examine workplace attitudes, stigma and discriminatory practices experienced by medical personnel affected by mental illnesses.
Seaton, Cherisse L., Joan L. Bottorff, John L. Oliffe, Kerensa Medhurst, and Damen DeLeenheer. 2019. “Mental Health Promotion in Male-Dominated Workplaces: Perspectives of Male Employees and Workplace Representatives.” Psychology of Men & Masculinities 20 (4): 541–52. https://doi.org/10.1037/men0000182
The Canadian study is exploring the gendered views of men and workplace representatives in male-dominated industries about workplace mental health promotion. It includes the need to “reduce stigma, capitalize on and build comradery, and to focus on enjoyable activities.” According to the article, based on Canadian National data, high demand-low control work, job insecurity, and work/family life imbalance are all associated with depression in men. According to the World Health Organization (2014) suicide rates are higher in men than women across the Western world and this may be in part due to specifically masculine ideals and norms that promote self-reliance and stoicism. According to the article it main objective are to “ (a) describe the gendered views of male employees and workplace representatives in male-dominated industries about workplace mental health promotion and (b) suggest recommendations for effective gender-sensitive workplace approaches to promote men’s mental health.” UK and Canada’s “Mental Health First Aid” and Australia’s “Mates in Construction” and “Mates in Mining” training are examples of programs designed to address men’s mental health wellness and norms related to masculinity, work related stress, concerns about job security, and male-specific stigma. According to the study Employee Assistance Programs confidential telephone counseling was being viewed as “basically for emergency crisis and management”. The study adds additional insight on gender specific biases that need to be accounted for when implementing mental health and wellness programs especially in male dominated industries such as construction, mining, forestry, oil/gas. One of the primary focuses should be reducing the stigma surrounding mental health and illnesses by “addressing misinformation, providing information about the prevalence of illnesses like depression (thereby “normalizing” mental illness), and showing the importance of mental health for workplace safety”.
Szeto, Andrew, Keith S. Dobson, and Stephanie Knaak. 2019. “The Road to Mental Readiness for First Responders: A Meta-Analysis of Program Outcomes.” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 64 (1 Suppl): 18S-29S. https://doi.org/10.1177/0706743719842562.
The Canadian study reviews the efficacy of the “Road to Mental Readiness for First Responders program”, a resiliency and anti-stigma program for first responders, given the high incidence of poor mental health, illness and suicide within this profession. The program addresses the need for increased resiliency training in first responders as well as providing ways to reduce the stigma of mental illness. Like Carleton, et al, the study reviews the effects PTSD, one of the mental illnesses highly prevalent within the first responders community. The results of the study showed the program was effective at reducing the stigma of mental illness and increased resiliency skills after program implementation in participants across 16 different sites and in 5 different first-responder groups. Additionally trainers for the program underwent additional training comprised of additional mental health background information. The efficiency of the training program was in line with other similar programs such as “The Working Mind” covered by Dobson et, al. and was adopted all across Canada by the first-responders community.
Szeto, Andrew, Keith S. Dobson, Dorothy Luong, Terry Krupa, and Bonnie Kirsh. 2019a. “Workplace Antistigma Programs at the Mental Health Commission of Canada: Part 1. Processes and Projects.” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 64 (1 Suppl): 5S-12S. https://doi.org/10.1177/0706743719842557.
The article offers an overview of “The Opening Minds Initiative of the Mental Health Commission of Canada”, a program meant to reduce stigma associated with mental health illnesses in the workplace. The article defines stigma as “multilayered process that begins when labels and stereotypes are attached to those with a human difference (e.g., a mental illness), which leads to the separation from the nonlabelled and can result in loss of status, prejudice, and discrimination towards those holding this difference”. The program’s core priority is to build on the strengths of and to promote already existing evidence-based programs which have proven efficacy, two of which being “R2MR” and “TWM”. According to the study beside the moral and ethical reasons, the negative financial impact to productivity caused by absenteeism, presenteeism and turnover is another strong reason to implement mental health wellness and stigma reduction programs in the workplace. “One estimate sets the cost of mental illnesses to the Canadian economy at approximately $51 billion a year.” The article also highlights the need of measuring the economic returns of implementation of such programs and does not expand on the economic losses sustained by employers due to mental illnesses effects on productivity.
Szeto, Andrew, Keith S. Dobson, Dorothy Luong, Terry Krupa, and Bonnie Kirsh 2019b. “Workplace Antistigma Programs at the Mental Health Commission of Canada: Part 2. Lessons Learned.” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 64 (1 Suppl): 13S-17S. https://doi.org/10.1177/0706743719842563.
The study is a follow up of the “Opening Minds” initiative focusing on its recruitment and adoption process in the workplace. According to the study, despite a couple of early adopters, less than 50% enrolled in the program. Many workplaces were resistant to formally committing to implement the program, even if offered at a low cost, due in part to senior management or executives having to acknowledge the potential impact of mental illness stigma, some of which even believed that implementation of such a program would imply this to be a problem within the organization, leaving it vulnerable to liability or lawsuits. Other organizations were open to some form of a program, but they were resistant to the idea of an evaluation as this may have been perceived as formal documentation of something otherwise acknowledge as a concern.
Studies like this highlight the critical importance of de-stigmatizing the adoption of this type of program in itself, there is a need to normalize the presence of mental wellness programs among employers, which can perhaps be incentivized economically to help boost adoption in the private sector.
Van Hasselt, Vincent B., Kristin E. Klimley, Samantha Rodriguez, Maureen Themis-Fernandez, Sarah N. Henderson, and Barry A. Schneider. 2019. “Peers as Law Enforcement Support (PALS): An Early Prevention Program.” Aggression and Violent Behavior 48 (September): 1–5. https://doi.org/10.1016/j.avb.2019.05.004.
Van Hasselt’s study is outlining the implementation of “PALS”, an employee mental health and resiliency program that was tailored for law enforcement personnel whose stressor factors are unique to their profession and combine occupational stress, trauma exposure and an enduring police culture. The program uses a trained peer system to identify risk factors for suicide, PTSD and other disorders like substance abuse, anxiety and depression. Studies have shown police officers were more comfortable with disclosing mental health challenges to their peers than to a mental health professional, at least in the beginning. The program is voluntary in nature and seeks to reduce the stigma of seeking mental help by providing training surrounding stress, active listening skills, depression, substance abuse, anxiety and PTSD, suicide, tactical wellness, relationships/work-life balance and scenario-based training. The program is an example of secondary prevention involving interventions for those who are already experiencing problems whereas a program like Van Hasselt, et al. “Behavioral Health Training” focuses on of preventing problems or psychological disorders from developing.
The study is relevant because it provides insight into the necessity of a multi-pronged approach, by using a combination of preventative type of programs combined with coping and monitoring type of programs.
